Sunday, August 12, 2012

How continued should accouchement absorb in foreground of the television? Parents charge to do added to stop accouchement spending too abundant time watching television or arena computer games, according to a psychologist.

Dr Aric Sigman said "screen time" bare to accept a circadian absolute in a agnate attitude to alkali or booze intake.

He alleged for parents to "regain control" or they were risking a "form of amiable neglect".

He will allege at the Royal College of Paediatrics and Child Health's anniversary appointment in Glasgow later.

Dr Sigman will altercate that the bulk of time spent in foreground of screens is at an best top - with accouchement accepting admission to an boilerplate of 5 screens in the home and generally application added than one at once, such as a smartphone and the television.

This is affiliated to a desk lifestyle, Type 2 diabetes and affection disease, he will say.

He will aswell accession apropos that it ability be alteration children's accuracy as they develop.

Brain scans accept apparent differences amid the accuracy of gamers and non-gamers. However, it is not accepted if arena amateur change the academician or if humans with assertive academician structures are apprenticed to play games.

Dr Sigman told the BBC that "there are apropos that it alters the accolade chip in the brain" which may advance to "dependence".

"Whether accouchement or adults are formally 'addicted' to awning technology or not, abounding of them overuse technology and accept developed an ailing annex on it."

He continued: "It is consistently the assumption of attention in children, except for awning time."

He is arguing that accouchement up to the age of three should accept little or no awning time. Then a best of an hour-and-a-half up to the age of seven, and a best of two hours up to the age of 18.

The adumbration accessible bloom minister, Diane Abbott, has aswell alleged for parents to cut the bulk of time families absorb in foreground of the television or arena on a computer.

She said: "By 2025, about bisected of men and over a third of women will be obese, so we've got to alpha allowance and allotment parents to do the appropriate thing."

Growth archive

The Department of Bloom said: "Physical action offers huge allowances - all accouchement should be encouraged to be active."

It said under-fives should absorb as little time sitting still as possible.

Meanwhile, doctors at the appointment accept adapted the way they analysis that accouchement are growing properly.

New advance charts, which are acclimated by doctors and academy nurses to analyze a child's height, weight and age, accept been developed to accomplish it easier to atom adipose accouchement and those not traveling through adolescence properly.

Dr Charlotte Wright, who was active in the design, said the new archive were "simpler to use" and would accord a "more authentic picture" of the bloom of children.

Friday, May 25, 2012

Doctors need to ensure relatives 'are fully-informed' In this week's Scrubbing Up opinion column, Prof Mayur Lakhani chair of the Dying Matters Coalition, urges doctors to be more open and frank about preparing patients and their families for the end of life.
Imagine a situation where most people with a common condition are undiagnosed and where opportunities are repeatedly missed to identify the problem and to offer good care.
What is this condition? It's dying.
Each year, an estimated 92,000 people in England are believed to need end of life care but not receive it.
As a practising GP I have seen distressed relatives after a patient has died in hospital.
Often they have not had a chance to see their relative before they died and were unaware of the seriousness of the condition, despite repeated admissions with deteriorating conditions.
Many such patients are never formally identified as at risk of dying and not assessed for end of life care.
One relative said something that haunts me to this day: "I wish the doctors had told me that my mother was dying."
As a result too many people still die in distress with uncontrolled symptoms, or have futile interventions when this will not make any difference.
All of us, including doctors, must do more to talk about dying.
'Too late'
A new ComRes research for the Dying Matters Coalition confirms there is a widespread reluctance to talk about dying and death.
That is why we want to encourage people to talk more openly about dying and bereavement and to make plans around end-of-life care.
Most people have not made a plan of their choices and wishes in the event of a serious illness.
People often think there is plenty of time when the situation arises but often this is not the case and it can be too late.
Doctors are trained to cure, but as people live with long-term conditions, the medical profession needs to change how it works with dying patients.
We need to bring dying back into people's homes, rather than in hospital, care homes or hospices.
As increasing numbers of people develop and live with dementia, it is vital that doctors talk about the kind of end-of-life care people would choose, while people are healthy.
There's a huge change required in our culture, starting with the medical profession.
Having learnt a lot from the Canadian communications expert Prof Stephen Workman, I would urge doctors to do three things.
First, be compassionate but direct when talking about dying.
Doctors speaking to relatives about an ill patient who is giving cause for concern, should not just say "your husband is seriously ill", but should add "It is possible that he could die". This allows all involved to prepare.
Secondly, be honest and don't offer false hope.
Think twice about offering a false choice of procedures like cardiopulmonary resuscitation (CPR) when someone is actually dying and chances of recovery are miniscule.
Instead offer supportive care to keep the patient comfortable and allow them to die a natural dignified death.
And, thirdly, when doctors diagnose a serious illness they should ask the patient whether they would like to talk about what they can expect and what is likely to happen.
Most people die from frailty in old age, and will be well known to health and social care services.
Importantly, this gives opportunities for talking about end of life wishes and advance care planning.
My ambition is to reduce the fear of dying and increase knowledge and awareness of palliative care.
It is vitally important that every person who is coming to the end of their life is spotted early enough and supported to make a good advance care plan.
I know just how hard it is to address issues like this in the frenzy of busy surgeries and wards.
But we as doctors need to up our game.
All of us, especially doctors can play a part in ensuring everyone is able to have a good death.

Wednesday, April 18, 2012

Have you ever gotten one of those scary chain emails telling you that your deodorant may cause breast cancer? If so, you are not alone. These show up in many people's in-boxes from time to time.
It has to do with certain underarm products that contain preservatives called parabens. These chemicals can act like the hormone estrogen in the body. Estrogen is known to fuel certain breast cancers. Many breast cancers develop in the part of the breast closest to the armpit, where antiperspirants and other underarm products are used.
Now a new study shows that yes, there is evidence of parabens in 99% of breast tissue samples taken from women with breast cancer, but many of these women did not use any underarm products. Most major brands of deodorants and antiperspirants no longer contain parabens.
So where are all the parabens coming from? Parabens such as methylparaben, ethylparaben, propylparaben, butylparaben, isopropylparaben, and isobutylparaben are also found in makeup, moisturizers, and hair care and shaving products.
The new study included 40 women with breast cancer who chose to have a mastectomy. Researchers looked at four samples of breast tissue from each woman. The tissue samples came from several locations within the breast, including the armpit region.
Fully 99% of the tissue samples had evidence of at least one paraben, and 60% showed evidence of five. Paraben levels did not seem to play a role in the cancer’s location or whether or not the cancer was fueled by estrogen.

Sunday, March 4, 2012

Acupuncture helps reduce days with migraines and may have lasting effects, according to a new study published in the Canadian Medical Association Journal.
In the study, almost 500 adults were treated with either traditional Chinese acupuncture or a sham treatment in which acupuncture needles were inserted in nonspecific points. The acupuncture treatment points were previously used to study migraine. Participants did not know which type of acupuncture treatment they were receiving during the four-week study.
After completing the study, all of the participants -- including those in the sham group -- reported fewer days with migraines than before the study began. Prior to the study, most suffered monthly migraines, on average six days of migraines a month. After the completing the study, they reported migraines on an average of three days in the month.
In the month following the treatment, all of the participants also reported improvements in the frequency and intensity of migraines.
However, lasting effects were seen only in study participants who received traditional acupuncture. Three months after treatment, people who received traditional Chinese acupuncture continued to report a reduction in migraine days, frequency, and intensity. People who received the sham treatment did not.
Although the study only showed a marginal benefit of real acupuncture over sham acupuncture, researcher Claudia Witt, MD, of University Medical Center Charité in Berlin, says previous research suggests that people who respond best to acupuncture treatments are those who have not been helped by other treatments and those who had past positive experiences with acupuncture.
Albrecht Molsberger, MD, a medical acupuncture specialist who wrote an editorial on the study, says that even in sham acupuncture, the simple insertion of needles into the skin, regardless of the exact points of insertion, can lead to fewer migraines and reduced pain.
“Putting needles in the patient twice weekly over six weeks does have a [physical] effect, but if we did it the Chinese way, we might be better off,” he says.
A previous study of 300 people showed that acupuncture is more effective than no acupuncture in the treatment of migraine. Another study of nearly 800 people showed that 11 acupuncture treatments over six weeks were at least as effective as the blood pressure drugs called beta-blockers -- often used for migraine prevention -- taken daily for six months, Molsberger tells WebMD.
“Acupuncture should be an option for the first-line treatment of migraine to supplement other non-[drug] treatment options,” he writes in his editorial.
Seymour Diamond, MD, who is executive chair of the National Headache Foundation, disagrees.
“That would be a serious mistake. Only after a patient has had a fair trial on both [preventive] -- if necessary -- and [rescue] medicine should they try acupuncture,” he says.
Is the benefit to acupuncture for migraine mostly a placebo effect, as a number of previous studies suggest?
“In any type of treatment, there is the expectation of results. And doctor’s interest alone should help a patient,” Diamond tells WebMD.
Ultimately, results will vary by the individual. “I don’t think acupuncture is really effective, but I never discourage a patient who wants to try it,” he says.

Thursday, February 2, 2012

Many people who have never had a heart attack or stroke take an aspirin every day to lower their risk for these events.

While some may benefit, for many others the benefits appear to be outweighed by an increased risk for potentially serious and even life-threatening bleeding, a new study shows.

Researchers analyzed data from nine large studies, including three published since 2007, which followed participants for an average of six years.

Aspirin therapy was not associated with a reduction in deaths due to heart attack and stroke, but it was associated with a significant increase in risk for bleeding, says researcher Kausik K. Ray, MD.

“The benefits of aspirin therapy are clear for patients who have a history of heart attack or stroke,” Ray says. “This is not the case, however, for patients who may have risk factors for [heart disease and stroke] but have no such history.”

The analysis included more than 100,000 people who had never had a heart attack or stroke and participated in trials in the United States, Europe, and Japan.

About half the participants took either low-dose (75-100 milligrams) or full-strength (300-500 milligrams) aspirin daily or every other day. Everyone else took placebos.

Over an average follow-up of six years, about 1,500 nonfatal and 500 fatal heart attacks and about 1,500 fatal and nonfatal strokes were recorded.

Aspirin therapy was associated with a 10% decrease in heart attacks and strokes, which was largely explained by a reduction in nonfatal heart attacks, Ray says.

But patients on the aspirin regimens were also 31% more likely to experience significant bleeding.

Aspirin therapy has been shown in several previous studies to be associated with a reduced risk of death from cancer, but the association was not seen in the new analysis, which was published in the Archives of Internal Medicine.

Ray and colleagues from the Cardiac and Vascular Sciences Research Center at St. George’s University of London conclude that for many patients with no history of heart attack or stroke, aspirin adds little to strategies proven to reduce heart disease and stroke risk.

These strategies include drug treatments that regulate blood pressure and cholesterol, and lifestyle changes such as smoking cessation, weight loss, and regular exercise.

The researchers add that more study is needed to identify patients who have not had heart attacks or strokes for whom the benefits of aspirin therapy outweigh the risks.

“In the absence of such information, a reappraisal of current guidelines appears to be warranted, particularly in countries where a large number of otherwise healthy adults are prescribed aspirin,” the researchers write.

Cardiologist Samia Mora, MD, of the Brigham and Women’s Hospital and Harvard Medical School, says patients need to discuss their individual risk for heart attack and stroke with their doctor before embarking on an aspirin therapy regimen.

In an editorial published with the paper, Mora writes that for low-risk patients the data “argue against the routine use of aspirin for primary prevention of [heart disease and stroke].”

“Right now, we really need to assess risk on a case-by-case basis,” she says. “For someone with a strong family history of heart attack or stroke, for example, a daily aspirin may be warranted even in the absence of other risk factors.”

New York University cardiologist Nieca Goldberg agrees that patients should always discuss their individual risks with their doctor before starting aspirin therapy.

When a runner dies during a marathon because their heart stops, it's big news -- and can be scary to the 2 million runners who participate in U.S. long-distance events each year.

However, the risk of cardiac arrest during long-distance races is relatively low, according to new research. A cardiac arrest occurs when the heart stops beating, and it's generally more serious than a heart attack.

Over a 10-year period, 59 runners, or 1 in 184,000 participants in half or full marathons, suffered cardiac arrest, says researcher Aaron Baggish, MD, associate director of the Cardiovascular Performance Program at Massachusetts General Hospital. He is also the cardiologist for the Boston Marathon. There were nearly 11 million participants during the decade studied.

Those who run a full marathon, 26.2 miles, are at higher risk of heart problems than those who run the half, he found. Men are at higher risk than women.

"It appears the half marathon is safer and better tolerated than the marathon," says Baggish. "Most of the problems we saw were marathon-related."

The study is published in The New England Journal of Medicine.

The new research, believed to be the first comprehensive study of marathon and half-marathon participants, may change the stereotypes. "The public perception is that marathons and half marathons are dangerous endeavors," Baggish says.

Veteran runners, on the other hand, may feel overly protected because of their healthy lifestyle, he says.

While the number of race-related deaths due to cardiac arrest has risen, "the increase in the number of cardiac deaths only parallels the increased number of participants," Baggish tells WebMD.

In 2000, fewer than 1 million participated in U.S. long-distance races. In 2010, 2 million did.

Baggish and his team tracked cases of cardiac arrest in half marathons and marathons in the U.S. from Jan. 1, 2000, through May 31, 2010.

They interviewed survivors or the family members of those who died. They reviewed medical records. They looked at post-death data.

Forty of the cardiac arrests occurred during marathons; 19 during half marathons.

Eighty-six percent of those who suffered cardiac arrest, or 51 of the 59, were men. The average age of those who had cardiac arrest was 42. Cardiac arrest was most likely to occur during the last quarter of the event.

Of those 59 cardiac arrests, 42 were fatal. Baggish says that death rate -- 71% -- is better than the 92% rate generally found when cardiac arrest occurs, when people are at home or in other isolated areas.

He credits the medical services at races and bystanders who performed CPR with this higher survival rate.

Next, Baggish looked at the causes. He had enough medical information to evaluate the cause for 31 of the 59 runners. An abnormal thickening of the heart muscle, known as hypertrophic cardiomyopathy, was often the confirmed or probable cause of death.

Among those who survived, underlying heart disease was the most common problem. Baggish found the risk of cardiac-related death over the 10-year period was 1 per 259,000 long-distance runners. Other research suggests that this risk is equal to or lower than that for other physical activity such as triathlons, college athletics, and jogging, he says.

Moms know it’s hard enough to keep kids away from germs when they’re at home. But during school hours, your little ones come across all different kinds of germ-filled situations. So how do you go about teaching your kids to avoid germs during the school day, or while they’re playing sports afterward?

“We live in a world of germs and you’re going to be exposed to them; it’s just a matter of trying to protect yourself as much as you can,” says Sandi Delack, RN, BSN, M ED, NCSN, a practicing school nurse in Rhode Island and president-elect for the National Association of School Nurses. “There are things you can do to minimize your risk,” says Delack, like washing your hands, and keeping your hands out of your mouth, eyes, and nose.

However, it takes a lot of repeating to get that message into kids’ heads, Delack says. “They have to hear it over and over, and they need to hear it at school, they need to hear it at home.” The earlier kids get the message the easier it’ll be on parents. “I’ll see kids walking down the hall all the time with the tie to their sweat shirt or their chain in their mouth and I’ll say, ‘Do you know how many germs are on that? Take that out of your mouth!’”

The bus ride to and from school is fraught with opportunities for close encounters of the germ kind. Delack says parents should be sure to tell kids that this is one time sharing isn’t a good thing -- so don’t share drinks or snacks; older kids should even be wary of talking on friend’s cell phone (or using it to text) if that friend has a cold.

Kids should also try to keep book bags off the floor, Delack says. And, parents need to set up a space far away from the kitchen counter or kitchen table -- anywhere food is prepared -- to stash school bags when kids get home.

So many classroom activities involve hand-to-hand contact: things like passing papers back down the row, or sharing pencils, pens, scissors and other tools. But it’s not touching things that belong to other kids that’s the problem, it’s what kids do after they touch an item. “The important part is they’re not putting their hands in their mouth and in their nose,” Delack says. That’s how germs have a chance to enter the body and that’s really how you get sick.

To counteract bacteria, many teachers purchase bulk supplies of hand sanitizer and tissues, then make them available to students throughout the year. Some schools ask each student to bring a box of tissues and a bottle of hand sanitizer and create the year’s supply that way. The key for parents is to remind kids to go get a tissue from the box or use the hand sanitizer when they need to.

Sunday, January 22, 2012

Our average life expectancy increased by about one month from 2009 to 2010. In 2010, the average life expectancy rose to 78.7 years, up from 78.6 years in 2009. These are some of the findings from a new report by the CDC on death rates in the U.S. in 2010.

The death rate hit its lowest rate ever in 2010, at 746.2 deaths per 100,000 people. Overall 2,465,936 people died in the U.S. in 2010.

Heart disease and cancer still top the list of causes of death. Together, they accounted for 47% of all deaths in 2010, the new report shows.

For the first time since 1965, homicide fell from the top 15 causes of death. Homicide was replaced by pneumonitis, an inflammation of lung tissue, as the 15th leading cause of death.

Of the top 15 causes of death in the U.S., there were drops in seven of them, including:

Saturday, January 21, 2012

Pregnant women who use certain popular antidepressants may have a twofold increased risk for delivering babies with a rare but serious lung disorder, a new study finds.

Researchers analyzed national registry data from 1.6 million births in five Nordic countries in an effort to determine if using selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy raises the risk for neonatal pulmonary hypertension, a life-threatening condition in newborns that normally occurs in one to two births in 1,000.

SSRIs such as Celexa, Lexapro, Paxil, Prozac, and Zoloft are the most widely prescribed class of antidepressants, and millions of women in the U.S. have used them during pregnancy.

Persistent pulmonary hypertension in newborns (PPHN) is a respiratory disorder in which the arteries leading to the lungs remain constricted after birth, limiting blood flow and oxygen.

Risk factors for PPHN include maternal obesity, diabetes, and smoking, and between 5% and 10% babies with the disorder do not survive.

A 2006 study first linked SSRI use during pregnancy to the disorder, finding a sixfold increase in the incidence of neonatal pulmonary hypertension in babies exposed to the antidepressants in the last months before birth.

Studies conducted since then have been mixed, with some supporting the association and others finding no increase in risk associated with SSRI use.

In the newly published study, researchers from Stockholm, Sweden’s, Karolinska Institute examined birth registry data from all babies born between 1996 and 2007 in Denmark, Finland, Iceland, Norway, and Sweden.

About 30,000 women used SSRIs during pregnancy, and about 11,000 filled prescriptions for them in their fifth month of pregnancy or later.

There were 33 cases of persistent pulmonary hypertension among babies whose mothers took SSRIs late in pregnancy, or about three cases per 1,000 births.

This was about double the number of cases that would have been expected in the general population of newborns, but babies born to mothers with a history of a previous hospitalization for a psychiatric disorder who were not taking SSRIs during pregnancy also had a slightly increased risk for the disorder.

Gideon Koren, MD, of Toronto’s Hospital for Sick Children, says the study raises more questions than it answers.

“This is by far the largest study to examine SSRI use and PPHN, but the fact that women with untreated depression had a higher risk for the disorder raises new doubts about this link,” Koren says. “Many doubts remain, and they should be shared with patients.”

Living in a sunny climate appears to reduce women’s risk of developing inflammatory bowel disease, a large new study shows.

An estimated 1.4 million people in the U.S. live with an inflammatory bowel disease, either Crohn’s disease or ulcerative colitis.

Both cause persistent diarrhea, abdominal pain and cramping, fever, and sometimes rectal bleeding. Symptoms can become very severe and sometimes require surgery.

Yet little is known about the causes of these diseases, which are thought to involve a dysfunction of the immune system.

For the new study, researchers combed through data on more than 238,000 women taking part in the long-running Nurses’ Health Study, which began in 1976.

The study collected information on where the women were living at birth, age 15, and age 30. It also recorded any diagnosis of an inflammatory bowel disease up to 2003.

Researchers also followed up with women who reported having inflammatory bowel disease and verified their diagnoses through medical records.

They found that women who lived in Southern regions that got a lot of sunlight had a 52% lower risk of being diagnosed with Crohn’s disease by age 30 and a 38% lower risk of getting ulcerative colitis than those who lived in Northern regions.

That result held up even when researchers tried to rule out other things that might increase a person’s risk for an inflammatory bowel disease, like having a family history.

“The differences are pretty drastic. That’s what surprised us the most. Especially when it comes to Crohn’s disease. We’re seeing a 40% to 50% reduction in risk,” says researcher Hamed Khalili, MD, a gastroenterologist at Massachusetts General Hospital in Boston.

The study is published in the journal Gut.

This study confirms previous research from Europe, and it suggests that the amount of UV light exposure from sunlight may play an important role in the development of inflammatory bowel disease, though researchers aren’t sure why.

One theory is that people in sunnier states may have higher exposure to UV light, leading to higher vitamin D levels. Vitamin D is known to help regulate immunity and inflammation.

Regional differences in environmental pollution or infections could offer other explanations.

“The study was well done,” says Amnon Sonnenberg, MD, MSc, a gastroenterologist at Oregon Health & Science University, in Portland. “The authors are to be commended,” says Sonnenberg, an expert on inflammatory bowel disease who was not involved in the study.

“We know quite well that there is a north-south gradient, and this north-south gradient applies to the American continent as well as to Europe,” he says.

But he says the reasons behind the regional differences are far from clear cut.

For example, he says, studies have shown that miners -- who spend their working hours underground and out of the sunlight -- have less inflammatory bowel disease.

For that reason, he cautions patients against thinking that taking more vitamin D might help their symptoms or lessen their risk if they have a family member who’s affected.

People tend to think “vitamin D is going to protect me,” Sonnenberg says, “And there is absolutely no evidence for this.”

Is your child a picky eater? A new study may help you expand his or her palate.

Children prefer much more color and variety in food presentation, compared to adults, according to the study. For example, children preferred twice as many colors and different items on their plates.

Children also responded well to figurative designs on their plate, like bacon “smiles” and peas arranged into a heart shape.

Researchers say the results suggest that parents can encourage picky eaters to eat healthier by introducing more color and creativity to their plates.

“What kids find visually appealing is very different than what appeals to their parents,” Brian Wansink, PhD, professor of marketing at Cornell University, says in a news release. “Our study shows how to make the changes so the broccoli and fish look tastier than they otherwise would to little Casey or little Audrey.”

In the study, published in Acta Paediatrica, researchers showed 23 pre-teen children and 46 adults full-size photos of different combinations of food on plates and asked them to choose which food presentations they liked the most.

The results showed children preferred plates with seven different items and six different colors, while adults favored plates with only three items and three colors.

“Compared with adults, children not only prefer plates with more elements and colors, but also their entrees placed in the front of the plate and with figurative designs,” researcher Kevin Kniffin, PhD, of Cornell University, says in the release.

Researchers found simple steps, like shaping a bacon strip into a smile at the bottom of the plate or arranging vegetables into fun shapes, made the food presentation much more appealing to children.

They say the next step is to test whether picky eaters actually eat what they say looks good enough to eat.

If so, giving children a wide array of foods on their plates may widen their palates and help them eat healthier.

They are typically prescribed when patients need medication to help control their blood sugar. A new research review, published in BMJ, reanalyzed data from 25 separate studies.

The review reveals that the drugs helped overweight people without diabetes shed an average of 7 pounds and those with diabetes lose an average of 6 pounds when injected daily or weekly for at least five months.

“It’s not a cure, but it’s a good treatment. And you still need to combine it with lifestyle changes,” says researcher Tina Vilsboll, MD, DMSc, an endocrinologist and associate professor at Gentofte Hospital in Hellerup, Denmark.

Vilsboll says the modest weight loss many of her diabetic patients see on the drugs helps encourage them to kick up their diet and exercise programs to lose even more weight.

“They use it as a tool for changing their lifestyle,” she says.

The medications also appear to lower blood pressure and cholesterol slightly, which may help heart disease risks.

But the drugs, known as glucagon-like peptide-1 (GLP-1) receptor agonists, also come with side effects. They work, in part, by slowing the movement of food through the stomach. That can sometimes cause a good deal of nausea or even vomiting, especially after a large meal.

But Vilsboll says that side effect generally fades over time and doesn’t usually cause people to stop taking the medication.

Experts who were not involved in the review say they are cautiously optimistic about the drugs’ prospects for weight loss.

“We do have an obesity epidemic. Weight loss by traditional means -- diet and exercise -- is extremely hard, and for people who are successful initially, it’s also very hard to maintain,” says Susan Spratt, MD, an endocrinologist and the director of diabetes services at Duke University Health System in Durham, N.C.

“If we could use these drugs just in people with obesity and know that it’s safe, I think it would be a fantastic addition to our ability to treat obesity,” Spratt says.

“I’ve had [diabetic] patients lose 60 pounds with these medications. Now, those folks were 400 pounds, so they lost 10% to 15% of their body weight,” she says. “Somebody who’s 200 pounds isn’t going to lose that much.”

Because the drugs are already on the market, doctors have the ability to prescribe them solely for weight loss.

Exercise and/or talking with a therapist on the phone once a week may significantly reduce chronic pain, a new study shows.

About 20% to 40% of adults report experiencing chronic pain, Seth Berkowitz, MD, and Mitchell Katz, MD, of the Los Angeles County Department of Health Services write in an accompanying editorial. Up to 20% of visits to a primary health care provider generate a prescription for a narcotic painkiller, or opioid, they say.

While three non-opioid drugs -- Cymbalta, Lyrica, and Savella -- have been approved by the FDA to treat fibromyalgia pain, none adequately controls the disorder’s multiple symptoms, the authors of the new study write.

The scientists assigned almost 450 patients with chronic widespread pain, some of whom had fibromyalgia, to get either “talk therapy” by phone, exercise, both talk therapy and excerise, or their usual treatment.

Four therapists underwent three days of training to learn how to provide psychological help to study participants receiving talk therapy. Patients chose goals, such as identifying and evaluating unhelpful thinking styles or making lifestyle changes.

After an initial assessment that lasted an hour, those participants receiving talk therapy spoke on the phone with a therapist for 30 to 45 minutes once a week for seven weeks. That was followed by a phone session three months and six months after the study began.

Evidence suggests that this talk therapy delivered by phone is as effective as face-to-face therapy, researcher John McBeth, PhD, an epidemiologist at the University of Manchester, tells WebMD in an email.

Those in the exercise group were invited to meet with a fitness instructor once a month for six months. The goal was to improve their fitness by exercising 20 minutes to an hour at least twice a week.

Three months after the study ended, the phone therapy and/or exercise patients showed more improvement than those who’d stayed with their usual care.

The people who engaged in both talk therapy and exercise did only slightly better than those who received one or the other. Perhaps the therapists included messages about exercise, the authors speculate. Or, they write, perhaps each treatment was so effective that there wasn’t much room for improvement by combining them.

The new study is the latest addition to an “extensive” body of clinical trials demonstrating talk therapy’s effectiveness in treating chronic pain and headache, says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at New York’s Beth Israel Medical Center.

“Cognitive behavioral therapy [talk therapy] should be offered to a far larger proportion of patients with chronic pain than currently is done,” Portenoy, who was not involved in the study, tells WebMD.

He cited several obstacles: Too few therapists trained to provide it, inadequate insurance coverage, a tendency among doctors to focus on medical strategies due to a lack of knowledge about talk therapy, and a lack of reimbursement incentives to offer other treatments.

Friday, January 20, 2012

An implantable device to treat chronic, severe acid reflux disease has moved one step closer to approval. An FDA advisory committee unanimously voted that the LINX device was safe and effective for treating chronic gastroesophageal reflux disease, or GERD, that does not respond to medication.

The panel also unanimously voted that the benefits of LINX for those patients outweigh the risks. The FDA usually, but not always, follows its advisory committees’ guidance.

The LINX device is a titanium ring of magnetic beads. It’s placed around the lower end of the esophagus to strengthen the sphincter, or ring of muscle, that’s supposed to prevent acid and other stomach contents from rising. At the same time, it is said to be pliant enough to allow food and liquids to enter the stomach.

Manufactured by Torax Medical of Shoreview, Minn., LINX has been on the market in the United Kingdom, Germany, and Italy for about two years, according to Todd Berg, the company’s president and CEO.

About 19 million U.S. adults suffer from GERD, FDA medical officer Priya Venkataraman-Rao, MD, told the panel. Doctors recommend treating it first with nonsurgical methods, such as raising the head of the bed, losing weight, eating smaller meals, or taking antacids or other medications called H2 blockers or proton-pump inhibitors.

If none of those work, the main alternative is a surgical procedure in which the top part of the stomach is cut and wrapped around the esophagus.

Torax implanted 100 patients with LINX in its pivotal clinical trial. On average, they’d suffered from GERD for 13 years and experienced about 80 episodes of heartburn a week. People with a BMI greater than 35, a large hiatal hernia (when the stomach bulges into the chest through an opening in the diaphragm), a history of trouble swallowing (more than once a week for the previous three months), a severely inflamed esophagus, or Barrett’s esophagus -- in which the lining of the esophagus, damaged by acid, becomes more like the lining of the intestine -- were excluded from the study.

The acid level in the patients’ esophagus was assessed before and 12 months after LINX was implanted via minimally invasive “keyhole” surgery. Just over half of the patients saw their acid level fall by at least one-half.

Improvement on a subjective quality-of-life assessment -- which asked such questions as when and how often heartburn occurred and whether it kept them up at night -- was even greater, both at 12 months and 24 months after surgery, Venkataraman-Rao said.

But because the study did not have a comparison group that did not get the device, there’s “no way of knowing whether subjects would have improved on their own,” Venkataraman-Rao said.

When it comes to the heart’s health, there are some things you can’t control -- like getting older, or having a parent with heart disease. But there are many more things you can do to lower the chances of sabotaging your ticker.

“An ounce of prevention really is worth a pound of cure in this instance,” says Gregg Fonarow, MD, an American Heart Association spokesman and associate chief of UCLA's division of cardiology.

To help your heart keep on keeping on, here are 10 things not to do.

A major cause of heart disease, smoking raises blood pressure, causes blood clots, and makes it harder to exercise. And it’s the number one preventable cause of premature death in the U.S., according to the American Heart Association.

Even though it may be one of the most difficult habits to quit, the rewards of stopping smoking are perhaps the greatest and most immediate.

When you toss the smokes, your heart risk goes down within just a few days of quitting. Within a year, your risk is cut by half. After 10 years of living smoke-free, it’s as if you never smoked at all, says Nieca Goldberg, MD, cardiologist and medical director of the New York University Women’s Heart Program.

When your heart literally aches and you don’t know why, it’s time to get checked out.

If you have chest pains while exercising, that’s a red flag. But if it happens after a heavy meal, it’s more likely to be your stomach causing trouble, says Goldberg, who is an American Heart Association spokeswoman and author of Dr. Nieca Goldberg’s Complete Guide to Women’s Health.

Heart pain can feel more like a pressure rather than actual pain. People tend to feel it in the front of their chest, with the sensation sometimes extending into the shoulders, up into the jaw, or down the left arm. If you feel like an elephant is sitting on your chest and you’re breaking out in a sweat, that’s an urgent matter. Call 911.

Regardless of what you’re feeling or when, even a doctor can’t tell if you’re in real trouble over the phone. So you have to seek medical attention in person to get a definitive answer for chest pain.

Having a family history of heart disease is a strong risk factor for predicting your own chances of heart trouble.

Having a parent who has had an early heart attack doubles the risk for men having one; in women the risk goes up by about 70%, according to an American Heart Association report from December 2010.

Unless your kid is using his room to harbor wild animals or make explosives, it's probably not a true health hazard. But it might get plenty yucky in there.

Could your teen's bedroom be a health hazard? With the piles of crusty socks, the old cereal bowls of curdled milk, and the mildewed towels, it certainly might look -- and smell -- that way.

Happily, as disgusting as your teen's messy room might be, it's unlikely to pose any serious health risks. "I've never seen any teenager who actually got sick because her room was unsanitary," says Tanya Remer Altmann, MD,a pediatrician and author of Mommy Calls and The Wonder Years.

How to Say No (Without Saying No)

By Barbara Aria"No." Kids hate to hear it, and you hate to say it — but how else can you keep them safe and well-behaved? Try one of these smart alternatives to just saying no. The average toddler hears the word no an astonishing 400 times a day, according to experts. That's not only tiresome for you but it can also be harmful to your child: According to studies, kids who hear no too much have poorer language skills than children whose parents offer more positive feedback. "Plus, saying no...

Read the How to Say No (Without Saying No) article > >

Of course, whether or not your teen's messy room meets the Department of Health's legal definition of a health hazard isn't really the issue. If your teen's bedroom is disgusting, and it bothers you, you need to do something about it.

"Teenagers need to learn how to look after themselves, and cleaning their rooms is part of that," says Charles Wibbelsman, MD, chairman of the Chiefs of Adolescent Medicine for Kaiser Permanente of Northern California and co-author of The Teenage Body Book. It's a basic responsibility and a skill they'll need as adults, he says.

So how can you get your teen to keep his or her room clean, or at least somewhat less disgusting? Here's some advice from the experts.

Unless your kid is using his room to harbor wild animals or make explosives, he's probably not created a genuine health hazard. But it still might get plenty yucky.

"If you can smell your teen's room down the hall -- because of old food or old laundry -- that's not sanitary," Altmann tells WebMD. "And it could even conceivably pose some health problems." Like what?

Mold. Depending on the weather, it won't take long for mold to start growing on a half-eaten sandwich. Large amounts of mold could actually affect the air quality and aggravate a person's allergies or asthma.Insects and other pests. As you've no doubt already said to your teen a thousand times, dirty dishes attract insects -- like ants and cockroaches -- as well as other pests like mice and rats. Dust mites can thrive in clutter. Finding any of these creatures in your house is disgusting. But some can carry disease as well as trigger allergies and asthma, Altmann says.Bacteria and other fungi. Some nasty things can grow on unwashed, damp clothing in a messy room. And if your teen keeps wearing the clothes pulled off the floor rather than out of the bureau, he could develop rashes and other problems -- like jock itch, which is caused by a fungus.

While you may be horrified by the revolting things that you discover in your teen's bedroom, you may still feel powerless to do anything about them. Asking, pleading, and screaming don't seem to work. So how should a parent handle it?

Transferring more than two embryos during an IVF cycle is a dangerous practice that does not improve a woman’s chances of delivering a baby, a European study finds.

Researchers analyzed close to 125,000 in vitro fertilization (IVF) cycles performed in the U.K. over a five-year period in one of the largest studies ever to compare outcomes in women younger than 40 to those of older women.

The conclusion that there is no medical justification for transferring three or more embryos, even in women over the age of 40, has major implications in the U.S., where 1 in 3 IVF procedures involves the transfer of more than two embryos.

While that represents a decline from a decade ago, when closer to 2 out of 3 IVF procedures in the U.S. involved three or more embryos, there is still plenty of room for improvement, a study co-author says.

“The practice of transferring multiple embryos is very much market-driven in the United States,” says Scott M. Nelson, MD, PhD, of the University of Glasgow Centre for Population and Health Sciences. “There is an economic incentive for transferring more embryos in the U.S., but no sound medical reason for doing so.”

New York infertility specialist Glenn L. Schattman, MD, disagrees. Schattman is president of the Society for Assisted Reproductive Technology (SART).

SART guidelines call for the transfer of one or two embryos per IVF cycle in younger patients with the best prognosis, and as many as four embryos per cycle in patients in their late 30s and 40s with a poor chance of achieving a pregnancy.

He says it is clear from SART’s own statistics that the poorest-prognosis patients have a much better chance of having a baby when more than two embryos are transferred.

“There is a continuous and constant decline in fertility with increasing age, so it makes no sense to treat a 39- or 40-year-old the same way we would a 26-year-old,” he says.

The 124,148 IVF cycles analyzed by Nelson and colleague Debbie A. Lawlor, PhD, of the University of Bristol, resulted in 33,514 live births.

The live birth rate was greater with the transfer of two embryos, compared to one, in women under the age of 40 and in women who were older. Transferring three embryos resulted in a lower birth rate than transferring two in the younger women and made no difference in outcomes in older women.

Compared to single-embryo transfer, transferring two or three embryos was associated with a higher risk for all adverse birth outcomes, including low birth weight and preterm delivery.

Not surprisingly, the overall live birth rate was lower in older women compared to younger ones, no matter how many embryos were transferred.

“A clear implication of our study is that [the] transfer of three embryos should no longer be supported in women of any age,” Nelson and Lawlor write.

Juicing is popular. But before you give it a whirl, you might want to know what it may -- and may not -- do for your health.

What are the nutritional benefits and drawbacks? Can you juice for weight loss? What about food safety and claims about cleansing your system? Here's what you need to know.

How to Eat Less and Enjoy It More

By Geneen Roth Want to cut calories without cutting out all your favorites? Learn to pay attention — real attention — to food. A few years ago, I was working on my laptop, developing a new workshop program, when one of my favorite series of all time came on TV — Pride and Prejudice (the one starring Colin Firth as Mr. Darcy, although let's be frank: Is there any other?). So I nestled into the couch, preparing to divide the next six hours between my work and Jane Austen's most...

Jennifer Barr, a Wilmington, Del., dietitian, often makes fresh juice as a snack for her kids. Her favorite juice combines kale, carrots, ginger, parsley, and apples. She then adds the leftover pulp from her juicing machine into muffins.

“If you’re not big into fruits and vegetables, it’s a good way to get them in. It can help you meet daily recommendations in one drink” and be part of a healthy diet, says Barr, MPH, RD, LDN, who works at Wilmington's Center for Community Health at Christiana Care Health System.

But you shouldn't count on juicing as your sole source of fruits and vegetables.

"Don’t think because you’re juicing that you’re off the hook with eating fruits and vegetables,” says Manuel Villacorta, MS, RD, CSSD, an Academy of Nutrition and Dietetics spokesman and founder of Eating Free, a weight management program.

Aim to eat two whole fruits, and three to four vegetables a day. They should come in different colors, as the colors have different vitamins and minerals, Barr says.

A juicing machine extracts the juice from whole fruits or vegetables. The processing results in fewer vitamins and minerals, because the nutrient-rich skin is left behind. Juicing also removes the pulp, which contains fiber.

You can add some of the leftover pulp back into the juice or use it in cooking.

Besides muffins, Barr uses other combinations -- such as spinach, pears, flaxseed, celery, and kale -- to make broth for cooking soup, rice, and pasta. She calls it "going the extra step to fortify your meals."

Juicers can be expensive, ranging from $50 to $400. Some more expensive juicers will break down a lot of the fruit by grinding the core, rind, and seeds, Barr says.

You may not need a juicing machine to make juice. You can use a blender for most whole fruits or vegetables to keep the fiber -- add water if it becomes too thick, Villacorta says.

If you've been diagnosed with psoriasis, it's important to be on the lookout for painful or swollen joints in your body that could indicate the development of psoriatic arthritis.

About 30% of people with psoriasis develop psoriatic arthritis symptoms, usually when they are between 30 and 50 years of age. Psoriatic skin lesions usually occur before the onset of arthritis. Early detection and receiving prompt psoriatic arthritis treatment are essential. Untreated psoriatic arthritis can result in permanent, crippling joint damage.

Since most people with psoriatic arthritis also have psoriatic skin lesions, it's important to balance treatment for your skin and joints. The good news is there are a variety of psoriatic arthritis treatments, including lifestyle habits and medications. Many are effective against psoriasis and psoriatic arthritis, meaning the same therapies can benefit your joints and your skin.

"At the moment, the key thing is awareness among patients with psoriasis and dermatologists who treat psoriasis to help prevent the progressive damage that can occur with psoriatic arthritis," says Seattle-based rheumatologist Philip Mease, MD.

Researchers don't know what causes some people with psoriasis to develop psoriatic arthritis. Evidence suggests that a combination of genetics and the environment can trigger an autoimmune response in which the body attacks its own tissues. That autoimmune response causes psoriatic arthritis symptoms, such as inflammation in the joints.

If you have psoriasis, you could be at risk of developing a variety of different forms of psoriatic arthritis, each of which can vary in severity among individuals and within a given person over a period of time. Psoriatic arthritis can be symmetric, meaning it occurs in the same joints on both sides of the body. But it is more often asymmetric, meaning it may affect the fingers of your left hand and toes of your right foot, for example.

For many people, the symptoms of psoriatic arthritis include swelling of the fingers and toes. They may take on a characteristic sausage shape, which is called dactylitis. If psoriatic arthritis affects the joints of your toes and fingers, it is most likely to strike the ones closest to the nail. Psoriatic arthritis can cause your nails to develop pits or peel away from the nail bed. In contrast, rheumatoid arthritis (RA) -- another autoimmune disease -- is more likely to affect the toe and finger joints closest to the hand or foot.

At times, psoriatic arthritis symptoms can cause your joints to be painful and stiff even when there is no swelling. In some instances, psoriatic arthritis leads to arthritis of the spine, known as spondylitis. In rare cases, it can lead to a disfiguring condition in the hands and feet called arthritis mutilans.

Regardless of which joints are affected by psoriatic arthritis, you may find you have morning stiffness and fatigue.

"The risk of [heart attack] or acute coronary syndrome is increased with [Pradaxa] compared with various control treatments, which include adjusted-dose warfarin, [Lovenox], or placebo," Uchino and Hernandez conclude.

Acute coronary syndrome -- acute symptoms of serious heart disease -- is usually caused by the rupture of a plaque in a heart artery.

In an editorial accompanying the study in the Jan. 9 issue of Archives of Internal Medicine, journal editor Rita Redberg, MD, notes that this isn't the first safety warning issued for Pradaxa.

The FDA is investigating an unusually large number of reports of serious bleeding linked to the drug. Japan and Australia already have issued a safety warning. The European Medicines Agency advises doctors to check patients' kidney function before prescribing Pradaxa. And last year the FDA warned patients that the drug breaks down quickly when removed from its original container.

Despite the apparent increase in heart attack risk, Uchino and Hernandez note that the benefits of Pradaxa -- particularly its ability to prevent stroke in patients with atrial fibrillation -- outweigh its risks.

And they note that while the risk of heart attack or acute coronary syndrome is higher in patients on Pradaxa than in those on warfarin, the actual risk of these events is increased by only 0.25% per year.

That's still an important added risk for patients who may already be piling up risk factors for heart disease, says Kirk Garratt, MD, clinical director of interventional cardiology research at New York's Lenox Hill Hospital.

While absolute risk may not be bad, when added on top of measurable risk it becomes worth noting.

"If I have a patient on this drug for 10 years, I'd expect a 5% increased lifetime risk of heart attack," Garratt tells WebMD. "The most important aspect of this study is that it allows us to see a consistent risk across studies and types of patients. That speaks to the conclusion that this study is well done and that the risk is real."

John Smith, MD, senior vice president of clinical development and medical affairs for Pradaxa maker Boehringer Ingelheim, does not agree that the study was well done.

While Garratt sees the diversity of studies as a strength, Smith says the different studies -- which compared patients taking Pradaxa for different reasons to patients taking warfarin, the blood thinner Lovenox, or placebo -- should not be lumped together.

Smith notes that a recent manufacturer-funded study found that the increase in heart attacks with Pradaxa is not large enough to be scientifically meaningful. But more important, he says, is that even the authors of the current study find Pradaxa's benefits to outweigh its risks.

"We have done the analysis and feel there is still a very favorable risk/benefit profile for the drug as prescribed in clinical practice," Smith tells WebMD. "We take the safety of patients taking our medicines as a top priority. This is something we actively monitor and are in communication with the FDA and other regulatory agencies. Safety is paramount in our minds."

Monday, January 16, 2012

How soon should your kids learn how to avoid cold and flu viruses? The sooner the better.

As your babies get older -- and grow out of that maddening I-must-put-everything-in-my-mouth phase -- you can start teaching them habits that will protect them from germs like cold and flu viruses. How soon? The sooner the better.

"Good hygiene habits are much easier to introduce when your kids are young," says Laura A. Jana, MD, a pediatrician in Omaha, Neb. and co-author of Heading Home with Your Newborn and Food Fights. "Bad habits are hard to break."

Adopting healthy habits for kids can have concrete benefits. Dodging just one or two of those day care cold viruses could save you a lot of misery. And healthy habits can help protect your child from swine flu this fall and winter. Even if the benefits aren't immediate, teaching healthy habits will pay off.

"If they start learning proper hygiene when they're young, they may not get sick as much when they're older," says TanyaRemer Altmann, MD, a pediatrician and author of Mommy Calls:Dr. Tanya Answers Parents' Top 101 Questions About Babies and Toddlers.

What Your Teen Isn't Telling You

By Valerie Frankel On a recent Tuesday afternoon, my daughter Maggie, 15, didn’t come home on time from school. I tried her cell phone; no answer. To my knowledge, she didn’t have any activities or specific plans. By five o’clock, genuine worry kicked in. My hand was poised over the phone. I had no idea whom to call. Her friend circle was in heavy rotation. At 5:13, she walked in, dropped her backpack on the floor, and said with infuriating nonchalance, "Hey. What’s for dinner?" "Where have you...

Read the What Your Teen Isn't Telling You article > >

So what sort of healthy habits for kids are realistic? Can a preschooler really learn ways to get protection from cold and flu viruses? Here's what the experts have to say.

When teaching healthy habits, focus on what's important. You probably don't need to lecture toddlers on the germ theory of disease. Concepts like contagion are probably too hard to grasp for little kids.

So instead of explaining, the key is to practice and ritualize some good behaviors. If you make them systematic, the odds are much better that you kids will stick with them -- and stay a little healthier as a result.

"If you make good habits part of a routine, it all becomes much easier," says Jana. "Your kids will do them without thinking."

When it comes to healthy habits for kids, hand washing is the most important one. To make it work, it's got to be built into their daily routines.

"Parents should make hand washing a ritual, like brushing their teeth," says Jana. You don't have to do it so obsessively that their hands get chapped. But you should always have your kids wash their hands:

When they arrive at day care or preschoolBefore they eatAfter changes or after using the potty or toiletAfter a play dateAs soon as they come in the house -- whether it's from school or from playing in the yard

The key is consistency. Get them to do it every time. If you do, your kids might start hand washing automatically. They might even start reminding you if you forget.

You already know that it's illegal if you're underage. But alcohol is often part of parties -- and some teens drink so much that they put their lives at risk.

"I've seen people come in barely breathing, they can't remember what happened the night before, they've thrown up, fell over, or peed on themselves, and ended up in the hospital with a plastic tube in their nose. There's nothing sexy or attractive about that," says Yale University ER doctor Darria Gillespie, MD, MBA.

And the earlier you start using alcohol or other drugs, the more likely you'll be addicted later on, Gillespie says.

What to do: Stay calm and say no. Pretty soon, people will forget about whether or not you're drinking. Bring your own cup to the party, filled with fruit punch and covered with a lid. That way you can say, "Thanks, I've got one," and change the subject, says Amee Nash, LPC, a counselor and community educator who has worked with teens and addiction for more than 10 years.

Or blame your parents, Nash says. Try one of these lines:

"If I do, this is the last time you'll see me at a party.""I'll lose my car if I get caught.""I was just grounded, so I don't want to get in trouble again."

Be aware that it wouldn't be hard for someone to slip something into your drink, such as a date rape drug like Rohypnol or GHB. So stick to nonalcoholic drinks, pour the drink yourself, and don't leave it unattended.

"Whatever is going to help you stay safe, do it," Nash says.

Apart from drinking games, there are some other dangerous party games you should absolutely never play.

Sunday, January 15, 2012

Understanding boys can be tricky. So here’s the inside scoop on what teen guys go through.

Boys usually begin puberty between the ages of 10 and 15. That's two years later than most girls.

Starting at about age 12 or 13, and as early as 9, hormones called androgens bring on a number of physical changes, says Lori Legano, MD, assistant professor of pediatrics at New York University and attending physician for the adolescent clinic at New York's Bellevue Hospital Center.

One of the first things guys start to notice is that their testicles and scrotum (the sac located underneath the penis) start to get larger. Their penis gets longer and wider and pubic hair begins to grow in, too.

Legano says male hormones are the reason for a number of other changes. Maybe you’ve noticed some of these developments in the boys you know:

Hair has started to grow on their faces.Hair under the arms starts to show up.Body odor becomes an issue.

Guys and girls have different timelines when it comes to puberty.

It breaks down like this:

Girls grow very fast (this could start as young as age 8), get their periods, their growth plates fuse, and they stop growing. Puberty over.

Boys, on the other hand, take their sweet time. They may not have a major growth spurt until age 15 or 16, and they sometimes keep growing into their early 20s.

That’s why around the 8th grade you have taller girls and smaller boys.

“Boys are slow to grow but then they catch up later,” Legano says.

Puberty is the fastest you’ll grow, other than when you’re a little baby, says Marc Lerner, MD, of the University of California, Irvine.

All that change can be awkward at times.

“Guys are also sometimes uncomfortable with how their body is changing in terms of height, their physical strength, or acne,” Lerner says. And, guys who develop slower and are smaller than other boys may feel really stressed about it.

On top of that, boys’ voices become deeper and may start to crack. Guys can blame their growing larynx, or voice box, for that.

If a boy seems pretty shy about talking to you or speaking up in class at this age, it could be that he feels awkward about his voice.

Want to prevent viruses from spreading in your home? These quick tips from the pros may help.

Taking care of a sick toddler isn’t fun. But taking care of two sick children is worse. It means more misery and sleepless nights -- and for you, more missed days of work.

So short of ordering everyone into hazmat suits, what are you supposed to do the next time one of your kids comes home from daycare flushed and feverish? How can you protect the rest of the family and prevent germs from spreading?

“I know some parents who just give up,” says says Tanya Remer Altmann, MD, a pediatrician and author of Mommy Calls:Dr. Tanya Answers Parents' Top 101 Questions About Babies and Toddlers. “They assume that once the virus is in the house, everyone’s going to get it. But there are some precautions that can help.”

Containing a virus isn’t easy -- especially within a family. But here’s some advice from pediatricians and experts on infectious disease on how to prevent germs from getting the rest of the family sick.

Get your kids to wash their hands. Yes, this one should be obvious. But it really can’t be stressed enough: hand washing is a crucial way to prevent germs from spreading. About 80% of infectious diseases are spread by touch.

“Two of the most important things we’ve done in medicine are getting people vaccinated and getting them to wash their hands,” says Robert W. Frenck Jr., MD, professor of pediatrics at the Cincinnati Children's Hospital Medical Center and member of the American Academy of Pediatrics’ Committee on Infectious Disease.

When you have a sick toddler, germs can get absolutely everywhere. That means that your healthy child is bound to pick them up on his hands. But as long as he’s washing his hands regularly, the germs might not make it from his hands into his eyes or mouth.

If kids are going to wash their hands, teach them to do it right. Experts recommend scrubbing hands for 20 seconds or so -- as long as it takes to sing “Happy Birthday” twice. The type of soap doesn’t matter -- to prevent germs, the regular stuff will work just as well as antibacterial soap.

When warm water and soap aren’t available, use an alcohol-based sanitizing gel -- just make sure to rub your hands together vigorously for about 20 seconds until the gel evaporates.Wash your own hands. To prevent germs from spreading, the same advice goes for you too. Don’t get so focused on wiping down your sick toddler’s toys that you forget to wash your own hands. It’s important for a couple of reasons. First, you don’t want to get sick -- taking care of a sick toddler while being sick yourself can be punishing.

But second, if you’re not washing your hands, you could actually be the one who infects your healthy child -- even if you don’t get sick. All it might take is for you to pick up your sick toddler’s tissues and then make your healthy kid’s lunch. Bingo: you’ve got two sick children.

Step up your disinfecting. Even if you’re not germ-obsessed usually, now might be a time to focus more on disinfecting surfaces in your home. It can help prevent germs from spreading.

“I think when one child is sick, some extra sanitizing around the house can definitely help prevent other family members from getting it,” Altmann tells WebMD.

What should you do? You could wipe off surfaces that your sick toddler has touched -- like doorknobs, tables, and handrails -- with a disinfectant. Many plastic toys can be thrown in the dishwasher, and many stuffed animals in the washing machine. If your sick toddler is suffering from vomiting and diarrhea, take extra care to disinfect the toilet, floor, and sink in the bathroom.

That said, don’t make yourself crazy in your attempts to prevent germs from spreading. You don’t want to spend your days following your sick toddler around the house, spraying everything in her wake with disinfectant. Besides, it won’t work. There’s no way that you’ll be able to eradicate all of the germs anyway.

We know alcohol makes many people feel good, and that it affects the brain, but new research goes a step further by tightening the focus on areas of the brain most likely affected by alcohol.

The new brain imaging research may lead to a better understanding of alcohol addiction and possibly better treatments for people who abuse alcohol and other drugs.

Investigators say they have identified specific differences in how the so-called reward center of the brain responds to alcohol in heavy and light drinkers.

In both groups, drinking alcohol caused the release of naturally occurring feel-good opioids known as endorphins in two key brain regions associated with reward processing.

But heavy drinkers released more endorphins in response to alcohol, and they reported feeling more intoxicated than the lighter drinkers after drinking the same amount of alcohol.

The findings suggest that people whose brains release more natural opioids in response to alcohol may get more pleasure out of drinking and may be more likely to drink too much and become alcoholics, researcher Jennifer M. Mitchell, PhD, of the University of California, San Francisco, says.

“Greater endorphin release was associated with more hazardous drinking,” Mitchell says. “We believe this is an important step in understanding where and how alcohol acts in the brain.”

Mitchell says the findings could lead to better versions of the existing alcohol abuse drug naltrexone, which blocks the opioid response and blunts alcohol cravings in some, but not all people.

Mitchell says a better understanding of the specific endorphin receptors involved in the alcohol “high” could lead to treatments that better target these reward centers. Currently, naltrexone takes more of a buckshot approach, affecting multiple receptors. This research could lead to more focused medications.

The University of California study included 13 people who identified themselves as heavy drinkers and 12 people who did not.

Using PET imaging, the researchers were able to measure opioid release in the brain before and immediately after the study participants drank the same amount of alcohol.

Drinking alcohol was found to be associated with opioid release in the nucleus accumbens and orbitofrontal cortex -- two areas of the brain associated with reward processing.

The study appears in the Jan. 11 issue of the journal Science Translational Medicine.

Although the nucleus accumbens has been previously associated with opioid regulation and reward processing, the involvement of the orbitofrontal cortex was unexpected, Mitchell and colleagues write.

Raymond F. Anton, MD, who directs the Center for Drug and Alcohol Programs at the Medical University of South Carolina, says it is likely that there are other, as-yet-unidentified regions of the brain associated with addiction.

“It is also likely that alcohol dependence is not one disease, but many, with many systems involved,” he says. “People drink for different reasons, so a treatment that works for one person may not work for another.”

Anton is conducting genetic research in hopes of discovering why naltrexone blunts alcohol cravings in some people but not others.

“We may be able to say in a few years if genetic predisposition can predict who will and will not respond to this drug,” Anton says.

Chinese Researchers Zero in on Coffee Substances That May Explain the Benefit

Coffee drinking has been linked with a reduced risk of diabetes, and now Chinese researchers think they may know why.

Three compounds found in coffee seem to block the toxic accumulation of a protein linked with an increased risk of type 2 diabetes.

''We found three major coffee compounds can reverse this toxic process and may explain why coffee drinking is associated with a lower risk of type 2 diabetes," says researcher Kun Huang, PhD, a professor of biological pharmacy at the Huazhong University of Science & Technology.

Previous studies have found that people who drink four or more cups of coffee a day have a 50% lower risk of getting type 2 diabetes.

The new study is published in the Journal of Agricultural and Food Chemistry.

Type 2 diabetes is the most common type. In those who have it, the body does not have enough insulin or the cells ignore the insulin. The hormone insulin, made by the pancreas, is crucial to move glucose to the cells for energy.

Other researchers have linked the ''misfolding'' of a protein called hIAPP (human islet amyloid polypeptide) with an increased risk of diabetes. HIAPP is similar to the amyloid protein implicated in Alzheimer's disease, Huang says. When these HIAPP deposits accumulate, they can lead to the death of cells in the pancreas, Huang tells WebMD.

The Chinese researchers looked at three major active compounds in coffee and their effect on stopping the toxic accumulation of the protein:

Caffeine Caffeic acid or CAChlorogenic acid or CGA

"We exposed hIAPP to coffee extracts, and found caffeine, caffeic acid, and chlorogenic acid all inhibited the formation of toxic hIAPP amyloid and protected the pancreatic cells," Huang tells WebMD.

All three had an effect. However, caffeic acid was best. Caffeine was the least good of the three.

In many of the entries individuals' negative attributes are listed, rather than their illnesses.

One record, written by John Underwood from Hastings, East Sussex, describes his children as ''quarrelsome'', ''stubborn'', ''greedy'', ''vain'' and ''noisy'' while he records himself as ''bad-tempered'' and his wife as suffering from a ''long tongue''.

Another unusual entry is from Thomas Wallace Young, who was described as ''bald and toothless''.

The cause of the suffragettes is also illustrated within the records, with some women listing their infirmities as not having the vote or not being enfranchised. For example, four women living in the same household recorded their infirmities as ''voteless, therefore classed with idiots and children''.

Others chose to make a note of their good health instead of the health problems the form enquired about, giving answers such as ''well'', ''healthy'', ''sane'', ''alright'', and even ''perfect''.

Evelyn Baker and her family from Leeds were recorded in the census by their father, Addiman Parkin Barker, as simply being ''alive'' and 72 entries said of their illnesses: ''none, thank God''.

The census also shows a correlation between infirmity and occupation. The biggest source of employment for blind men and women was basket-weaving. Other trades for blind men were as musicians or musical instrument makers.

Women who were deaf and dumb were often employed within the textile or garment trades, or in domestic service, while men were most likely to be labourers.

Debra Chatfield, family historian at findmypast.co.uk, said: ''The infirmities column is the last piece of the jigsaw completing the 1911 census. This column alone provides a fascinating insight into life a hundred years ago.

''It not only reflects health conditions, but also a time before society became aware of political-correctness and certain terminology was deemed acceptable.

''In the more unusual entries we also get a wonderful sense of post-Edwardian humour, society and family dynamics at this time.''

Audrey Collins, family history records specialist at The National Archives, said: ''The information in the infirmities column being released today helps add an extra dimension to the picture of our ancestors' lives in 1911.

''We have to remember that the census returns were completed by relatives living in the same house who for the most part had no specialist medical knowledge.

''Their descriptions provide us with a clue as to how each individual was viewed by other family members, although many would have been reluctant to admit that their relatives suffered from any defect.''

By all current assessment, that makes me a raging social alcoholic and groups me with the girl in the purple miniskirt and white court shoes, splayed face down on the pavement outside a pub in central Manchester on a Friday night. But I credit myself with a more sophisticated approach to my drinking, something akin to Madame Bollinger’s to champagne: “I drink champagne when I’m happy and when I’m sad,” she said “Sometimes I drink it when I’m alone. When I have company, I consider it obligatory. I trifle with it if I’m not hungry and drink it when I am. Otherwise, I never touch it – unless I’m thirsty.”

Quite so, except I tend to drink water when thirsty and I am extremely fussy about the quality of wine that I drink. If it is disgusting, I will not take more than a couple of sips. I am a middle-class, middle-aged social drinker with taste – and that, I believe, is the saving grace when it comes to my alcohol intake. Unfortunately, the NHS does not agree.

For the purposes of research, I visited the NHS Choices website, which provides a link to an online gadget that calculates whether you drink too much. “How often do you have 6 or more units [three glasses of wine] of alcohol on one occasion,” it asks. I tick “Weekly”.

“How often during the last year have you found that you were not able to stop drinking once you have started?” I tick “Weekly,” wanting to add, “because it was so delicious.”

“How often have you needed an alcoholic drink in the morning to get yourself going?” “I’m not that bad,” I mutter in protest, ticking “Never”.

Then a window pops up on screen saying it is ''concerned’’ about my overall drinking habits. It does not advise Alcoholics Anonymous, but says to stop friends topping me up, and to join in activities that do not involve drinking.

I bristle. This makes me sound as if I drink all day every day, when the truth is that I am amazed I can fit in the units I do consume, so busy am I not drinking. If I have to write or do other work the next day, I may only drink a glass, but quite often nothing at all. I cannot, like some legendary alcohol-fuelled authors, produce decent prose on a bottle or two of wine.

Included in non-drinking time are household and family chores, shopping trips, dog-walking and an occasional run in the park – and sleeping, of course. Ideally, I prefer not to drink between Sunday night and Friday afternoon. I do drink more at weekends. This puts me back in the purple miniskirt as a “binge drinker”, hints my NHS cyber-confidant. “But you do not understand,” I plead with the screen. “I drink nicely, not disgustingly.”

I am not being flippant, nor am I unaware of the tragic consequences of drinking heavily – and addiction. Some 25 years ago, a close relative died of a stroke, the result of liver disease, when he was only 53. He had been told to stop drinking, and could not. Afterwards I became curious about the psychological side of alcoholism, attending AA family group meetings and consulting experts. Learning at what point a drinker becomes an alcoholic, I found the differential being when your drinking is an obvious cause of harm to yourself and others.

I have a stronger head than many. I do not slur my words or stagger when drunk. I may talk louder and laugh easier, but I don’t start singing ballads or get angry. I have noticed, however, that now I am older my head is less clear the next day, which is why I do not drink when full concentration is needed. After drinking too much, I may wake with a painful headache and feel spaced out and shivery until late afternoon. Wine also makes me fat.

So I am, in every sense, a controlled drinker, adapting my intake of alcohol and its consequences to the demands of my life. But I do still worry about my liking for it. A recent week long trip to a “dry” state in the Middle East filled me with enough foreboding to ask for several refills on the plane. Meze without wine, I thought gloomily. I did not feel panicky about it but very petulant.

Oh dear. On paper this does not look good. Avid wine drinkers may do better not to try and explain their passion and habits, when medical advice is so black and white. The health authorities do not discriminate over social-economic status, genetics or the choice of “poison” – organic, biodynamic wine or Mike’s Hard Lemonade. Yet, my conclusion is that there is only one person who knows if you are overdoing it: yourself. And while I still have a choice in the matter of whether or not to pour myself a drink, I do not think I drink too much. Do I?

Alcohol – good or bad?

While most of us know that heavy drinking is harmful, there is confusion as to whether a regular, moderate tipple is good or bad for our health. Here’s what the best research has established:

Light or moderate drinking reduces the risk of heart disease by a quarter compared with not drinking at all, according to a large study that included all types of alcohol. But heavy drinking increases heart disease risk.

Alcohol increases the risk of breast cancer in women, bowel cancer in men and cancer of the mouth, throat, voicebox and gullet (oesophagus) in both sexes, says the World Cancer Research Fund. It also probably increases the risk of liver cancer, and bowel cancer in women.

Where cancer is concerned, there seems to be no safe level: one UK study found that, for middle-aged women, even low to moderate consumption significantly raised the risk of breast cancer.

Light to moderate drinkers have a significantly reduced risk of dying earlier (with wine having the strongest effect). Heavy drinkers increase their risk of an early death.

Pregnancy: heavy drinking is harmful to the unborn baby but less is known about light or moderate consumption. Pregnant women are advised to avoid alcohol altogether if possible.

The conclusion? Moderate drinking has modest benefits for the heart but may also raise cancer risk. It’s wise to stick to recommended limits: no more than 3-4 units of alcohol a day for men and 2-3 units daily for women.

A unit is about equal to half a pint of ordinary strength beer, lager or cider and a small measure (25ml) of spirits. A small glass (125ml) of wine contains about 1.5 units.

Tuesday, January 10, 2012

But it said the 5% of women who had their implants on the NHS as part of breast reconstruction surgery will be able to have them removed and replaced if they are concerned, and following consultation with their doctor.The Government said it expects private firms to offer the same deal to anxious women who also wish to have their implants removed.A Government review ordered by Health Secretary Andrew Lansley has concluded there is no clear evidence that patients with PIP implants are at greater risk of harm than those with other implants.Advice from the Medicines and Healthcare products Regulatory Agency (MHRA) has not changed: there is still no evidence of health risks to support routine removal of the implants.But experts behind the review concluded that anxiety is a form of health risk and recognised that many women would be anxious.

Monday, January 9, 2012

Professor Rawlins, the chairman of the National Institute of Health and Clinical Excellence, said the economic pressure on trusts meant that “completely illegal” decisions were being made to limit the use of expensive drugs.He told the Financial Times: “I just wish a patient organisation would take a Trust to court for failing to comply.”Nice has been criticised for ruling against the prescription of expensive new drugs on the grounds that they are not cost-effective.But Sir Michael told the paper that most of Nice’s recommendations were in favour of prescription and that it was other bodies that blocked the drugs’ use.Sir Michael criticised the local lists of approved medicines drawn up across the NHS which “second-guess” and sometimes ignore Nice recommendations.

Ministers have agreed to pay for the removal of the French-made silicone products for women who had them on the NHS, and have called on private clinics to acknowledge their “moral duty” to offer the same service.Although the Department of Health said it would “pursue private clinics with all means at its disposal to avoid the taxpayer picking up the bill”, it confirmed on Friday night that it would help women if their clinic was no longer in operation or refused to care for them.Officials say the implants – thought to have been fitted in some 52,000 women who wanted larger breasts for cosmetic reasons or after cancer surgery – only need to be replaced if they have ruptured but will also carry out the procedure if the patients are worried about them.Most independent providers have agreed to provide free surgery for their patients who received implants made by the now-defunct Poly Implant Prothèse – which were filled with non-medical grade silicone intended for use in mattresses – at least one is holding out while another has so far refused to reveal its policy.Transform Cosmetic Surgery said the Government needed to “accept its responsibility” for the problem as the implants had been approved for use by a watchdog, the Medicines and Healthcare products Regulatory Agency.

Experts have warned that elderly patients are being discharged too early, putting their health at risk and increasing the likelihood of them being readmitted to hospital.The full scale of the cuts emerged after a year in which the NHS faced sustained criticism for its treatment of the elderly.The Daily Telegraph surveyed 172 NHS trusts about how many beds they had closed.Of the 39 trusts which responded, it emerged a total of 469 hospital beds have been cut since April 2010. Of these, 259 were specifically elderly beds.According to the latest Department of Health figures, 17% of the 121,000 beds in NHS hospitals are for the elderly, suggesting that managers have deliberately targeted elderly beds for cuts.

The therapy for basal cell carcinoma, the most common form of skin cancer, uses a radioactive isotope to kill tumour cells in just half an hour while leaving the skin around it unharmed.

Although it has not yet been approved for use, a study of 1,000 patients in Rome found it completely removed tumours in 95 per cent of patients with just one treatment.

Larger trials have been set up in Germany with the intention of bringing the therapy to the market.

Basal cell carcinoma is caused by exposure to harmful UV rays from natural light or sunbeds and accounts for about 80 per cent of all skin cancer cases, or 90,000 cases a year in Britain.

It not normally metastatic, meaning it does not spread through the body or pose a threat to life, but the routine treatment is surgery which although effective can leave unsightly scars.

In some cases, for example where the tumour is on the face, there are alternative ointments and light-based therapies but most are only suitable for lumps which do not penetrate too deeply into the skin.

Now researchers say they have developed a new cream using rhenium-188, a radioactive isotope, which can kill even deep tumours without side-effects in the vast majority of cases.

A base layer applied directly onto the skin protects healthy cells from the radioactive element, which sits on top of the base where it can irradiate the skin below and shrink the tumour.

It could dramatically improve the quality of life of patients who could otherwise require skin grafts and face serious scarring as a result of surgery, researchers said.

Dr Ulli Köster, a researcher at the Institut Laue-Langevin (ILL) in Grenoble, France, where the radioactive material is produced, said: "Typically this disease is treated by surgery, and since it doesn't metastase this is usually OK.

"But the problem is if the tumour is on the face, on the nose, ear or somewhere, it is strongly disfiguring – someone can have a big scar or lose half of his face.

"This is a localised radiation therapy which in more than 95 per cent of cases a single treatment is sufficient to make the cancer go away."

Dr Maria Gonzalez, a dermatologist based at Cardiff University, said: "It is very specific types of patients who would choose this treatment.

"It would be very useful to have as an alternative to surgery. Sometimes if the tumour is very large, especially on the face, or the patient is elderly then it is not a reasonable approach to excise it (cut it out)".

Martin Ledwick, of Cancer Research UK, added: "I would imagine we are not talking about a major breakthrough but another option. It is nice to have a menu of different options for people, particularly with things that can have a cosmetic impact."